Provider Demographics
NPI:1629074802
Name:BROWN, BRIAN L (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:L
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1775 ALYSHEBA WAY
Mailing Address - Street 2:STE 201
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2279
Mailing Address - Country:US
Mailing Address - Phone:859-278-5007
Mailing Address - Fax:859-278-6867
Practice Address - Street 1:1775 ALYSHEBA WAY
Practice Address - Street 2:STE 201
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2279
Practice Address - Country:US
Practice Address - Phone:859-278-5007
Practice Address - Fax:859-278-6867
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY27058207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64270580Medicaid
KY64270580Medicaid
KY1369303Medicare ID - Type Unspecified